Provider Demographics
NPI:1508432436
Name:OTHMAN, AMIRA MOHAMED AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIRA
Middle Name:MOHAMED AHMED
Last Name:OTHMAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:804 SERVICE RD STE A202
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-364-5440
Mailing Address - Fax:517-364-5409
Practice Address - Street 1:1200 E MICHIGAN AVE STE 145
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1897
Practice Address - Country:US
Practice Address - Phone:517-364-5440
Practice Address - Fax:517-364-5409
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2024-06-20
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Provider Licenses
StateLicense IDTaxonomies
MI4301510926208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty